Expert: Meg - 7/25/2007

Question

I am a 41 year old female with 28 years of anorexia. I have spent much of this time at dangerously low weights and last year dropped to 3st13 at 5ft 4. Over 14 months I have got my weight up to 5st9. I discharged myself from hospital at this weight as I could not cope with how fat i looked compared to other anorexics on the unit. But my main question is why do I still feel so weak and ill? My legs hurt and I cannot walk like I want to. Stairs are hard. I want to be able to run and jump, ride a bike etc. Is it too late, is there too much damage? how can I get stronger? I do not have the strength to exercise to increase muscle mass so am in a catch22 situation. My BMI is 13.5. I could do so much more at this weight in my twenties. Some people say I should exercise to strengthen my legs but I do not have the strength. The hospital physio said i cannot exercise until I have more muscle ie gain more weight. But if I gain weight and do little, won't I gain fat not muscle? I walk as much as I can, but that is all the exercise I can do. I feel so fat and lazy and look so much more than I weigh. people keep telling me how well I look which makes me think I must look fine whereas others at higher weights look ill. is it because I am all fat and no muscle i look so fat? Please help me. I so want to have a life after 28 years of hell but am terrified it is too late for my body to recover. i am so depressed and have panic attacks. I started prozac yesterday.Me and Mum are moving in 2 weeks and I want to start a new life but have no strength or energy to do all i want to. My GP said it will take a long time and I need to gain more weight but he cannot say for sure when/if I shall feel better and strong. My worst nightmare is becoming true - I am not only weak but also fat now. At least when I was thin I could understand why I was weak and had hope that if I gained weight I would feel better. But I have gained all this weight and still feel so crap, worse if anything. Surely I should feel stronger and energetic at my weight? Did I mention I am on 1300 cals daily? I want to get stronger but not even fatter so am striggling with trying to increase my diet.I eat little and often and find it hard to eat fruit etc as it bloats me. I worry my diet is unhealthy but I like things like chocolate. Yesterday I had 2 weetabix 150ml semi skimmed, a sausage roll, slice apple tart. salmon in sauce, 4 mini boiled pots and broccoli, 1 chocolate biscuit, 1 plain biscuit plus milk in tea and coffee.My stomach is huge and bloated all the time and I am constipated. My thighs are huge and flabby as are my arms, my hips are so wide and my bum sticks out miles. I would so love to be as thin as Victoria Beckham. How come some people can be so thin yet strong and healthy? Why do I look fatter than people who weigh more than me? Is it cos I have lost all muscle so my weight is all fat? What weight would I feel strong at and be able to exercise or is it too late? I have abused my body for so long and am so scared it will never recover. I want to have a life but am so restricted in what I can do. I also have severe osteoporosis for which I take Calcium and Fosavance. Sorry this is so long. I have asked a couple of other experts, one replied, the other said it was out of her expertise. please help me.


Answer
Hi Sonia,

Thank you for your question and I will try my best to help as much as I can.  I'm so sorry that you've been through so much and think that it is almost never too late to recover and take concrete steps back towards health.  

I am really awful at metric conversions but it looks to me like you are still really underweight for your height.  This as well as your overall health not being great is probably adding to your already off body image that is telling you that you are fat.  If you want to get over your eating disorder, then it is precisely this type of thinking that you have to be able to identify as eating disordered thinking and then although you will probably still *feel* fat, put aside those feelings and know that it is nothing more than your anorexia lying to you.  

Your BMI is still again extremely low and unhealthy.  As a rule, a healthy range for BMI for adults is between 18 and 25.  Now, while I give you a whole lot of credit for all of the work you've put towards recovery thus far (and I know it is not at all easy and probably has been the fight of your life), physically you probably still have a ways to go.  

I agree with the hospital doctor that its probably not good for you to exercise too much until your weight is more stabilized.  Some walking is fine as I understand that it can be hard not to do anything, but its really important if you want your body to recover that you give it the time to do so.  If you exercise and restrict right now, you'll lose the hard earned progress you have made and slip back further into your eating disorder.  Also, if you really wanted to exercise more right now, that would mean you would need to consume more calories as to offset those you would burn.  I would guess that this is not something you probably want to do (which is understandable) but you certainly are not at a point where you can stand to lose any weight at all.

You are NOT fat right now.  You "feel" fat, and there is a huge difference.  I have been there and I understand that feeling fat can seem as horrible as being terribly fat but again if you want to move forward you are going to need to see (or else trust me and take a leap of faith) that you are not fat even if you feel that way.  If you need to, take a look at the logical supporting evidence you have.  You are still extremely underweight, your BMI is way too low and you still feel weak and sick.  You may feel fat because you have gained some weight and that is not easy (which is why therapy can be helpful in dealing with that) but you are still a ways from where you will need to be to be healthy.

As for people telling you that you look "healthy" or better or whatever, this is a time old trigger for those of us who have had eating disorders.  To us (the ED sufferer) this means "you have gotten fat", however I have found that to the speaker of such a remark it usually means that you don't look "as sick" or else sometimes even that they know you are working on recovery and don't know what else to say.   You look well would appear (to someone who had not had an ED) to be a compliment, but its easy for someone recovering to take it as something horrible.  I promise you that it wasn't meant in any way but to show support and love to you.

As for being able to do more in your twenties even (I'm guessing) at a low body weight and while restricting, the sad truth is that with time our bodies get broken down more and more and even without having an eating disorder, as we age they can not put up with as much as before.  

Although I had my eating disorder for a shorter time than you, I know that it took me awhile to really start to feel okay again.  I've heard from others who have struggled for a really long time and HAVE indeed recovered so I know it is possible.  As for when you will feel better, I don't know for sure and I wish I had a firm answer.  I can say that I know that every day you are able to take steps towards putting this behind you, doing healthy/good things for your body, nurturing your spirit and letting happiness and good things come back into your life, you will feel gradually better.  It truly is a process, though, and one that I've found you have to have patience and a little bit of faith that your body will follow once you make the decision to treat it with the respect and love it deserves.

As for your diet, I'd say at this point I would worry less about how healthy it is and more that you are getting your calories.  Of course, its best to have a balanced diet and I've no doubt that you will get there, but right now your body is really in survival mode and it needs energy in whatever form to keep going.  If you've not worked with a dietician at all, you might think about doing that if its possible as that can really help you understand exactly what your body needs and why.  This often helps people feel a little more comfortable with eating and being good to their body as they progress in recovery.

I'm going to answer some of your questions here :

"My thighs are huge and flabby as are my arms, my hips are so wide and my bum sticks out miles."
This is the voice of your eating disorder (I know, it sounds a little bit cheesy but its so true here) and is not reflective of reality.  Its simply the false belief system of an eating disorder that keeps you doing whatever it takes to say with your eating disorder.  Hopefully, you can begin to identify thoughts like this as EATING DISORDER, not reality.  That can be one challange for you this week.



"I would so love to be as thin as Victoria Beckham."
Its easy to fall into the comparison game, but you are YOU.  You are the only you there is and you, alone, have your own unique gifts to the world.  There is already one Victoria Beckham and she's doing her thing in her own skin.  There is also one Sonia and unfortunately, she is stuck right now not doing her thing.  But she can do it again.  Be the best YOU you can be.  You're probably thinner than Victoria, but really it doesn't matter.  While we have all done the comparison game, it really leads nowhere and only is another little trick your ED plays on you.

"How come some people can be so thin yet strong and healthy?"

It is possible to be thin and strong and healthy.  It is NOT possible to have an eating disorder and be thin, strong and healthy.  

"Why do I look fatter than people who weigh more than me?"

You don't.  You only look fatter to YOU and this is because you still have an eating disorder and it is making you see yourself very inaccurately.

Is it cos I have lost all muscle so my weight is all fat?

Nope.  It is impossible for your weight to be all fat.  Its because your mind is telling you that its fat and you feel uncomfortable because you've gained some weight and are deviating from what "a good eating disordered" person does.  That is going to feel wrong, but its not and its what you are going to feel as you get healthier.  The better you get, the less frequently you will feel this way.  I promise you this.

What weight would I feel strong at and be able to exercise or is it too late?

I don't know, as that is so dependant on the individual.  However, I agree with your doctors that I wouldn't do much exercise until you are at a truly healthy weight and have made some headway in terms of the psychological aspects of your eating disorder.  

Its good that you're taking Calcium and I encourage you to keep up with your physicians and continually monitor your health as the body does take some time to get healthy and especially after 28 years.  But, it is possible and every day that you take even baby steps forward is a gift to your body.  

Its great that you want a life and although I still hear a lot of your eating disorder in this post, I also can tell that there is a part of you know who knows that there is a life beyond this.  And, it is so much better, fuller, richer and full of promise than life with an eating disorder could ever be.

What are your goals?  What do you secretly dream?  What is most important to you (other than weight)?  What intrigues you?  All of these things are also important to think about because as you continue to get healthier you will have more and more time for the things you truly love in your life.  This is, to me, the really exciting part of recovery.  

I don't know if you've worked with a therapist at all, but you might consider doing so as these patterns can be so very difficult to break and its nice to have the support and insight of someone who has an outside perspective.  I also don't know if you've given any thought to this question but it might help you do to so.  If you were suddenly as thin as you think you need to be, what would your life be like?  What would you have that you don't have now?  If you can identify these things, then you have found what you REALLY want.  While it may feel like controlling your weight will give you these things, its not true.  And, it can be quite helpful to really look behind the weight and see what it is that you are really after.

I feel like I've rambled on and on and perhaps not even fully answered your question.  I hope this helps at least a little and please take good care and know that it IS possible.  Write anytime and let me know if there is anything else I can help with or just how you're doing.

Best,
Meg